Abstract
BackgroundEmergency presentation with colon cancer is intuitively related to advanced disease. We measured its effect on outcomes of surgically treated colon cancer. MethodsA retrospective cohort of 1,071 surgical colon cancer patients (2004 to 2011), with 102 emergency cases requiring surgery within the index admission, was analyzed. ResultsEmergency patients required longer surgeries (median 141 vs 124 minutes; P = .04), longer median admissions (8% vs 5%; P < .001), more readmissions (12.7% vs 7.1%; P = .040), and perioperative mortality (7.8% vs .8%; P < .001). Surgical pathology displayed higher rates of node-positive disease (56.6% vs 38.6%; P < .001), extramural vascular invasion (39.6% vs 29.1%; P = .021), and metastatic disease (19.6% vs 8%; P < .001). Consequently, adjusting for staging, emergency presentations had considerably higher mortality (odds ratio = 2.07; P = .003) and shorter disease-free survival (hazard ratio = 1.39; P = .042). ConclusionsEmergency presentation is a stage-independent poor prognostic factor associated with aggressive tumor biology, resulting in longer surgeries and admissions, frequent readmissions, worsening outcomes, and increasing healthcare costs.
Highlights
IntroductionDetection leads to 5-year survival rates that can be as high as 97.4% for early stage disease
There were no differences in regards to a history of smoking, but emergency presentations had higher rates of current smokers (17.6% vs. 11.4%; P=0.062) and a history of alcohol abuse (12.7% vs. 7.4%; P=0.059)
An emergency department (ED) presentation is related to a multifactorial high- risk profile, making it a stage-independent prognostic factor
Summary
Detection leads to 5-year survival rates that can be as high as 97.4% for early stage disease. Emerging evidence has already shown that certain symptoms on presentation predict advanced disease and poorer outcomes. Emergency presentation is expected to be an unequivocally poor prognostic factor in patients with colon cancer, as the symptoms that lead patients to present at an emergency department (ED), including intestinal bleeding, perforation, or obstruction, are usually attributable to advanced disease. This article analyzes colon cancer patients who are admitted after emergency presentation and eventually undergo surgical resection for colon cancer. It assesses the magnitude of the effects associated with emergency presentation on staging, surgical stay, and cancer-related outcomes
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